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careful inquiry into the family histories did notreveal any hereditary tendencies, heredity has playedan important part in a number of the recorded cases,as in the family reported by Dubreuil-Chambardel,in which the grandmother, mother, and two daughtersall had exophthalmic goitre ; and in that describedby Souques and Lermoyez, in which there were sevencases. In several instances, as in those reported by z,Gaucher and Salin, Hazen and Rost, syphilis wasthought to be the underlying factor, but in none ofDr. Heiman’s cases was there any history or evidenceof that disease. Of the three cardinal symptoms ofexophthalmic goitre-tachycardia, exophthalmos, andenlargement of the thyroid gland-Barret states thattachycardia is the first to develop in children. The

exophthalmos is usually less marked in children thanin adults, though it is rarely missing. In Barret’sseries it was absent in only eight cases. The basalmetabolism test, which is the most important diag-nostic guide, was performed in Dr. Heiman’s cases,and showed that the degree of severity of the symptomsand signs corresponded with the degree of elevationof the metabolism rate, the results before treatmentbeing in the first case 12 per cent., in the secondcase 20 per cent., and in the third case 52 per cent.Dr. Heiman maintains that the most rational treat-ment of exophthalmic goitre is, first, a regimen ofstrict physical and psychical rest for a period of 6-10weeks. If the patient then shows no improvementa short stage of X ray treatment should be employed.If there is then no response, thyroidectomy should beperformed. Considerable improvement took placein one of Dr. Heiman’s cases in which partialthyroidectomy was carried out. In the other two

cases, in which rest was the only treatment, theimprovement was less striking.

THE CAUSATION OF THIRST.

THE sensation of thirst, so familiar yet vague andelusive, has often aroused the curiosity of the investi-gator, and at least two theories are current to explainits origin. Thirst might be due primarily to loss ofwater from the tissues in general, the actual sensationbeing a secondary local reference to the pharynx ; or

it might be a consequence simply of loss of water fromthe mucosa of the mouth and pharynx, and inde-pendent of the general state of the tissues. Somewell-known facts point to the one theory and some tothe other. Thus, the rapidity with which thirst isquenched by drinking water or by such devices asthe sucking of a lemon, or the antidipsic button usedby soldiers in arid climates, both of which promote aflow of saliva, point to the local desiccation theory ;so does the thirst familiar to the nervous orator,or that engendered by atropin. An experimentalinvestigation by G. T. Pack,l of Yale, gives furthersupport to this view. He sought to learn whetherpilocarpine, by promoting a flow of saliva, exerted anantidipsic effect, and found that it did. Rabbitsdeprived of water for a sufficient period were offeredwater for a certain length of time and the amountconsumed was noted. Similar rabbits treated withpilocarpine took much less water even in double thetime ; yet the general desiccation of the tissues wouldprobably, if anything, have been greater after pilo-carpine than before, on account of the flow of digestivejuices.While all these facts seems to be arrayed in favour

of the local desiccation theory of the origin of thirst,there is a not inconsiderable body of evidence infavour of the general tissue-desiccation theory. Forinstance, thirst can be allayed or prevented by intra-venous or rectal injections, or by the administrationof water by a stomach tube. Again, the thirst ofdiabetes or of chronic polyuria is not assuaged bypilocarpine. Mere wetness or dryness of the mucosaof thelmoiith and pharynx is therefore not the onlyfactor. Pack’s rabbits, although they took less water

1 Amer. Jour. Physiol., 1923, lxv., 346.

in a given time with than without pilocarpine, never-theless frequently took some water; thirst was reducedbut not abolished. A compromise between the twoviews would be not unreasonable. Local dryingapparently always produces thirst; local dryingwould obviously be greatly accelerated and wouldreach the sensation-point sooner if there was a

generalised desiccation ; sensations arise first fromthe pharynx because, though normally moist, itsopportunities for drying are greater than in othermucous membranes, owing to its forming part of therespiratory tract, and possibly also being endowed with

special end-organs sensitive to drying.i

THE LISTER WARD IN THE ROYAL INFIRMARY

OF GLASGOW.

CONSIDERABLE feeling has been aroused both inand beyond Glasgow by the recent decision of themanagers of the Royal Infirmary to demolish theLister Ward, the workshop in which that great surgeonevolved his antiseptic treatment of wounds. Theward forms part of the old Lister block, which wasleft intact in the precincts of the present Infirmarywhen the plans were published in 1907, and it standssome 60 feet from the new building. The entireblock has been condemned, but public sentimentfinds expression in a petition, already signed bylarge numbers among the medical profession and thelaity alike, that at least the first storey-the ListerWard-should be retained as a memorial of one towhose fame Glasgow is proud to have contributed.The reason for the managers’ decision appears to bethree-fold : that the ward is not suited to modernrequirements of surgery, that the space occupiedis essential for light and air, and that to retain theward would affect the symmetry of the Infirmaryforecourt. To these utilitarian, hygienic, and aestheticgrounds for total demolition is added the cost ofreconstructing the ward when the upper storeys areremoved. All four arguments are ably disposed ofby Mr. James A. Morris, F.R.I.B.A., in his pamphletentitled, "A Humble Plea for the Retention of theFamous Lister Ward in the Royal Infirmary, Glasgow." 1On the purely technical side of these questions expertadvice must prevail, but the main issue at stake inthe public mind is one which has again and againbeen a matter of controversy in recent years, andwhich amounts to this : is it justifiable in present-daycircumstances to sacrifice a part (however small) ofa modern conception to sentiment, and to honoura great pioneer of progress by an act of conservatism ?If the continued use of the ward should in any wayimpair any patient’s chances of recovery, then toprotest against its demolition would be folly ; butit was those who had the most direct interest in thewell-being of their patients-the medical staff of theTnfirmary-who were the first to sign a petitionpleading for the retention of the ward. Surely, then,even at a small financial outlay, and, it may be, at theexpense of the hypersensitive aesthetic taste of a few, itis justifiable-nay more, it is a civic duty, to preservethis historic battlefield in the age-long fight againstdisease, as an inspiration for those who follow after.

THE LONDON SCHOOL OF DERMATOLOGY.

FOR a long time it has been realised that dermatologyin London has suffered from want of concentrationand combined effort. Each of the large Londonhospitals has its dermatological department, forwhich, as a rule, one physician alone is responsible.St. John’s Hospital for Diseases of the Skin providesa centre where there is ample material, and wherethere are also considerable facilities for concertedteaching, but up till now these various interests havebeen working independently. During the last fewmonths negotiations have been proceeding betweenthe medical staff of St. John’s Hospital and other

1 Glasgow: Maclehose, Jackson and Co. 6d.